title: Course and management of renal subcapsular abscess in a 63-year-old diabetic woman.
abstract: Renal subcapsular abscess is a very rare disease that is defined by a suppurative process localized to a space between the renal capsule and the renal parenchyma. The course and management of subcapsular abscesses have received less attention than those of renal and perirenal abscesses. We describe a 63-year-old diabetic woman who presented with intermittent fever of 1 month's duration. She was initially treated for suspected acute pyelonephritis then referred to our hospital because of poor clinical response to cefazolin plus gentamicin. Computed tomography of the abdomen revealed a huge subcapsular abscess with displacement and compression of the left renal parenchyma. A percutaneous catheter was inserted and left in place for 8 days; a total of approximately 850 mL of pus was drained. Culture of the pus yielded Klebsiella pneumoniae and Enterobacter cloacae. A 2-week course of moxalactam was administered on the basis of the results of in vitro antibiotic susceptibility testing. The distorted renal parenchyma appeared normal at sonographic follow-up examination 3 weeks after hospitalization. The course and management of this rare entity are presented as a reminder to physicians that renal subcapsular abscess could manifest as fever of unknown origin in a diabetic patient. A high degree of clinical suspicion is required for early diagnosis and treatment in order to achieve a satisfactory outcome.
authors.affiliation: Department of Internal Medicine, China Medical College Hospital, Taichung, Taiwan.
authors.forename: W L
authors.initials: WL
authors.lastname: Yu
authors.forename: S N
authors.initials: SN
authors.lastname: Jean
authors.forename: H J
authors.initials: HJ
authors.lastname: Chiang
mesh_terms: D000038:Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D016972:Enterobacter cloacae; D004756:Enterobacteriaceae Infections / Q000175:diagnosis / Q000188:drug therapy; D005260:Female; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy; D007711:Klebsiella pneumoniae; D008875:Middle Aged; D011704:Pyelonephritis / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology